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Charity and Uninsured Care

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What is the Purpose?

Lenox Hill Hospital is committed to rendering care to patients regardless of their ability to pay part or all of their medically necessary care.

Lenox Hill Hospital conveys to prospective patients and to local community agencies that the Hospital has a financial aid policy that is consistent with the mission and values of the Hospital and takes into account each patient’s ability to contribute to the cost of his or her care and the Hospital’s financial ability to provide the care. This policy covers hospital services only and does not include any physician or professional services.

What is the Policy?

Lenox Hill Hospital patients in need of financial assistance are required to provide to the Hospital accurate and complete information, including the necessary documents and any and all financial and other information needed to enroll in a publicly sponsored insurance program if required. Patients who do not complete an application for charity care assistance and provide income verification will automatically qualify for the highest level of the uninsured fee schedule.

The Hospital will communicate this policy to the public by the following means:

  • The Hospital will conspicuously post in all registration areas of the Hospital the telephone number that patients may call to obtain further information on the Hospital’s charity care policy. Signs are posted announcing our Charity Care policy in English, Spanish, and French to better accommodate our patient population.
  • The Hospital’s computerized billing statements will include information on the charity care policy including contact information, telephone numbers and an Email address for any patient requesting assistance.
  • The Hospital website will provide a link to the Charity Care policy, summary, application and appeal forms.
  • Payment deposits required for non-emergent, medically necessary care will be included as part of the financial assistance determination

Lenox Hill Hospital has determined a sliding scale fee for uninsured or underinsured patients that equal a percentage of the current Medicare DRG rates for Inpatient services and a per cent of charges for Outpatient services.

This rate applies to only uninsured patients and insured patients who incur some cost sharing related to limited or exhausted insurance carrier benefits.

This policy covers patients who have applied to the hospital for financial assistance and meet the requirements for financial assistance. Uninsured patients who do not complete an application will be charged the maximum level of the fee scale for the appropriate service area.

Consideration for a sliding scale fee based on financial need requires that the patient or responsible party provide income verification. A copy of their most recent pay stubs for the household, verification of residency, and a completed application are required prior to admission for elective services to determine the appropriate sliding scale fee level. Immigration status will not be a factor in determining the patient’s eligibility for charity care.

>>Download the application form

The hospital’s Financial Services Department will respond in writing with a decision on all completed applications for Charity Care assistance within 30 days from the date of receipt. The Hospital will allow applications to be submitted up to 90 days after discharge and allow an additional 20 days for submission of additional documentation.

Outpatient Charity Care Fee Scale*

LEVELAnnual Income RangeFamily Size
LowHigh%FPLUp to 23+
A$10,830.00$20,799.00100%3%1%
B$20,800.00$41,999.00200%8%4%
C$42,000.00$52,800.00300%12%9%
D$52,801.00$70,400.00400%19%13%
E$70,401.00$88,000.00-24%20%
F$88,001.00$105,600.00-27%25%
G$105,601.00$125,000.00-32%28%
H$125,001.00$150,000.0039%33%
I$151,000.00+ >40%40%

The Outpatient Fee Scale will be applied against the current Total Charge rate incurred for each service.

Inpatient Charity Care Fee Scale

LEVELAnnual Income RangeFamily Size
LowHigh%FPLUp to 23+
A$10,830.00$20,799.00100%10%5%
B$20,800.00$41,999.00200%20%11%
C$42,000.00$52,800.00300%30%21%
D$52,801.00$70,400.00400%45%31%
E$70,401.00$88,000.00-65%46%
F$88,001.00$105,600.00-85%66%
G$105,601.00$125,000.00-100%86%
H$125,001.00$150,000.00125%101%
I$151,000.00+ >150%126%

The Fee Scale will be applied against the current Medicare DRG rates.
Inpatient Psychiatric services will be charged at a rate of $1,200.00 per day.

There is a separate fee schedule used for Cardiac, Orthopaedic, Gastric and Maternity services that is available upon request from the Hospital’s Financial Services office.

A nominal payment amount will be charged to patients whose income falls below 100% of the Federal Poverty Level (FPL) and do not qualify for Medicaid coverage. The nominal payment is $150 for inpatient, $150 for each ambulatory surgery procedure, and $150 for MRI services. A fee of $15 will be charged per visit to the emergency room and adult clinics. There will be no charge for any patient at or below 100% of the FPL for prenatal and pediatric clinic and emergency room services. The nominal fee is the lowest amount to be charged for any qualifying service.

The New York State (HCRA) Surcharge of 9.63% will be applied to the fee scale rate.
Personal items and the Private Room differential charges are not covered by the fee scale.

Appeal Process

Patients receiving a denial on their application will be encouraged to file an appeal if there are extenuating circumstances or have additional information regarding their financial position. The appeal form will be mailed to the patient’s home and will also be available on the Hospital website. .The applicant will receive written notice of the appeal determination within 30 days of receipt of the appeal form. Download Appeal Form.

Primary Service Area

The Hospital’s Primary Service Area is defined as the 5 counties of New York City. Residents of New York City will be eligible for the Charity Care fee schedules.

The Secondary Service Area is defined as all counties of the United States outside of New York City. U.S. citizens residing outside of New York City will be subject to rates of 200% of the Medicare DRG rate for Inpatient services and 60% of charges for outpatient services.

The Tertiary Service Area is defined as foreign territories outside of the United States of America.
Foreign patients whose primary residence is outside of the United States will be subject to payment of 100% of total charges for all Inpatient and Outpatient services.

The Hospital reserves the right to exercise discretion in applying the Charity Care Fee schedule to patients residing outside the primary service area.

Installment Plans

The Hospital will accommodate flexible installment plan arrangements with the patient where the monthly payment will not exceed 10% of the patient’s gross monthly income. There is no interest charged on installment plans and there is no interest penalty for a missed payment.

Billing and Collection

The Hospital’s staff will be trained to administer this policy and provide assistance to the patient. The patient will be informed that they may disregard billing statements until a final decision is reached on their application.

The Hospital will treat all patients with dignity and respect in regards to debt collection activities. The Hospital and any external collection agencies contracted with the Hospital must adhere to the Hospital’s Code of Ethics and follow collection practices that are in compliance with the Federal Fair Debt Collection Practice Act.

Contracted collection agencies are required to comply with the Hospital’s financial assistance program. The Hospital will not send an account to collection while the application for financial assistance is pending a final decision. The patient will receive written notice at least 30 days prior to referring an account to collection. Patients who are eligible for Medicaid at the time of service will not be referred to collection.

The Hospital will not force the sale or foreclosure of a patient’s primary residence to pay an outstanding bill but the Hospital does recognize its rights to initiate legal action where there is evidence that the patient or responsible party has the resources to meet his or her obligation. Collection agencies must get written approval from the Hospital prior to commencing legal action.

The Hospital will produce internal reporting to monitor compliance with the terms of our financial assistance program.